癫(癎)减停药后复发危险因素分析

目的 回顾性分析癫(癎)发作获得控制患者减停药后复发情况及相关危险因素,以为临床应用提供参考依据.方法 采用单因素分析和向前逐步法多因素非条件Logistic回归分析评价311例癫(癎)发作获得控制且减停药≥2年患者的癫(癎)复发危险因素.结果 311例患者,癫(癎)复发率为34.73%(108/311),其中在医师指导下减停药者280例,癫(癎)复发率为29.29%(82/280),停药后1年内复发率为26.43%(74/280),停药后2年内复发率为28.21%(79/280).单因素分析结果显示,青少年期发病、成年期发病、肌阵挛发作、青少年肌阵挛癫(癎)、症状性部分性癫(癎)、减药前大发作频率>10次、成年期减药、成人减药前无发作时间<4年、减药时间<6个月及减药前脑电图显示(癎)样放电共10项因素是减停药后癫(癎)复发的危险因索,差异具有统计学意义(均P<0.05).多因素非条件Logistic回归分析结果显示,青少年期发病、成年期发病、青少年肌阵挛癫(癎)、症状性部分性癫(癎)、成人减药前无发作时间<4年、减药时间<6个月及减药前脑电图显示(癎)样放电为减停药后癫(癎)复发的主要危险因素(均P<0.05).结论 癫(癎)减停药应该注重个体化原则.儿童期发病的癫(癎)患者发作控制1～2年可考虑减停药,成年患者发作控制>4年方可考虑减停药,减药时间应≥6个月.青少年期发病、成年期发病、青少年肌阵挛癫(癎)、症状性部分性癫(癎)及减药前脑电图显示(癎)样放电者,减停药后癫(癎)复发风险高,减停药需慎重.     

世界卫生组织-全球抗癫痫运动中国农村癫痫示范项目结束后四年随访结果

目的了解全球抗癫癎运动中国农村抗癫癎示范项目终止后4年曾接受苯巴比妥治疗的癫癎患者的远期治疗效果及转归,以为我国农村癫癎患者的防治和管理提供参考依据。方法 2008年7-12月由经过培训的乡卫生院医师采用问卷与访谈相结合的形式入户调查,对原示范项目6省(市)共8个县经苯巴比妥治疗管理的2455例惊厥型癫癎患者进行随访。结果接受苯巴比妥治疗的2455例患者中共随访到1780例,其中939例(52.75%)继续服药,无发作和发作减少超过50%(有效)的患者于项目终止后的12、24、36和48个月时所占比例分别为66.77%(627/939)、68.37%(642/939)、71.35%(670/939)和73.06%(686/939);841例(47.25%)停药患者中244例(29.01%)无发作、320例(38.05%)仍然发作但已停药、277例(32.94%)改用其他类型抗癫癎药物。对939例继续服用苯巴比妥与841例停药的癫癎患者进行疗效比较,继续服药者的远期疗效优于停药者(χ~2=12.423,P=0.002)。停药原因分别为发作停止(244例,29.01%)、改用其他抗癫癎药物(277例,32.94%)、未提供免费药物或无钱买药(93例,11.06%)、治疗效果欠佳(92例,10.94%)、当地买不到苯巴比妥(54例,6.42%)等。至2008年随访结束时共有206例患者死亡,标化死亡比达19.10;其中意外事故死亡为59例(28.64%),其次为脑血管病30例(14.56%)、癫癎持续状态窒息死亡28例(13.59%)。结论 "全球抗癫癎运动"中国农村癫癎示范项目开展成功,远期治疗效果良好,值得进一步推广。癫癎人群死亡率高,尤其是意外事故死亡率高,值得引起注意。     

难治性癫癎持续状态麻醉药物治疗失败相关因素分析

目的筛查难治性癫癎持续状态麻醉药物即刻治疗失败的相关因素。方法采用单因素和多因素前进法Logistic回归分析筛查难治性癫癎持续状态麻醉药物即刻治疗失败(治疗6 h仍未终止发作)危险因素,计算最终治疗失败率。结果单因素和多因素Logistic回归分析显示,在性别、年龄、病因、急性生理学和慢性健康状况评估Ⅱ、癫癎持续状态类型、初始抗癫癎药物种类、初始治疗总时间、院前初始治疗时间、院后初始治疗时间、难治性癫癎持续状态类型和首选麻醉药物种类等影响因素中,仅初始治疗总时间为即刻治疗失败的独立危险因素(OR=1.007,95%CI:1.000~1.014;P=0.047)。难治性癫癎持续状态麻醉药物即刻治疗失败率为50%(15/30),最终治疗失败率约43.33%(13/30)且即刻治疗失败组高于即刻治疗成功组(10/15对3/15,P=0.025)。结论难治性癫癎持续状态麻醉药物即刻治疗的成败取决于初始治疗总时间,并与最终治疗成败密切相关。因此,在治疗原发疾病基础上,应尽早开始终止癫癎持续状态或难治性癫癎持续状态的抗癫癎药物治疗。     

托吡酯添加治疗转换为单药治疗癫疒间56例疗效观察

目的观察添加托吡酯(TPM)治疗有效的癫癎患者转换为TPM单药治疗的疗效.方法对56例添加TPM治疗有效并持续6个月以上的患者,逐渐减、停合用的抗癫癎药,转换为TPM单药治疗.结果转换成功32例(57.1%),完全控制13例,显效15例,有效4例,恶化4例,中途退出20例;不良反应减少14例次(35.8%).结论添加TPM治疗有效且稳定的非难治性癫癎患者大多数可成功转换为TPM单药治疗,而难治性癫癎患者转换为TPM单药治疗的成功率较低.     

上海农村地区癫痫流行病学抽样调查

目的了解上海农村地区癫癎患病率和治疗缺口,为开展癫癎治疗和管理工作提供依据.方法以二阶段整群抽样法抽取金山区吕巷镇的5个村作为调查点,实际调查10 777人.癫癎病例经初筛及神经科医生复查后确诊.结果确诊癫癎为65例,终生患病率6.03‰(95%CI5.58‰～6.48‰).活动性癫癎为41例,患病率为3.80‰(95%CI2.64‰～4.96‰).活动性癫癎的治疗缺口为70.73%(95%CI56.80%～84.66%).癫癎患者平均年龄为(44.66±18.73)岁,首次发病的平均年龄为(26.28±18.71)岁,首发年龄在30岁之前的患者占61.54%.癫癎的发作类型以全身强直-阵挛性发作为主,占58.46%.结论农村地区癫癎患病率高于以往的调查结果,应重视对农村儿童和青年期癫癎的治疗和管理.     

卒中后癫癎发作时间分布及影响因素的研究

目的 分析卒中后癫癎发作时间分布特点,并对其影响因素进行研究.方法 将122例卒中后癫癎发作患者分为早发性癫癎发作组(卒中后2周内出现癫癎发作)60例;晚发性癫癎发作组(卒中2周后出现癫癎发作)62例.进行单因素及多因素分析,研究患者的基础情况,卒中的危险因素、卒中的类型、癫癎发作的类型、发作频次、治疗等情况与早发及晚发的关系.结果 性别、年龄、卒中危险因素以及脑电图改变在两组间无差异.缺血性卒中出血转化是卒中后癫癎发作早发的危险因素;早发性癫痫发作倾向于表现为全面性强直阵挛发作,晚发性癫癎发作倾向于表现为部分性发作;颞叶病变是卒中后癫癎发作晚发的危险因素;晚发性癫癎发作倾向于复发.早发性癫癎发作患者接受短期治疗的比例较高,晚发性癫癎发作患者接受长期治疗的比例较高.Logistic多元回归提示糖尿病是卒中后癫癎发作早发的危险因素(OR=2.664,95%CI=1.143～6.210,P=0.259).结论 糖尿病和缺血性卒中出血转化为卒中后癫癎发作早发的危险因素;而颞叶病变是卒中后癫癎发作晚发的危险因素,且晚发性癫癎发作更倾向于复发.     

癫(癎)患者出现新发作类型的临床研究

目的 探讨癫(癎)患者新发作类型出现的比例及可能原因,为正确诊断、治疗和预防癫(癎)提供依据.方法 回顾性研究1074例癫(癎)患者的临床资料,分析癫(癎)患者新发作类型的发生率、可能原因、脑电图和神经影像学结果、家族史及神经系统检查.采用独立样本秩和检验比较有或无新发作类型出现的癫(癎)患者的发病年龄及病程差异.X2检验比较有或无新发作类型出现的癫(癎)患者的性别、家族史、神经系统检查以及脑电图和神经影像学出现异常比例的差异.结果 1074例患者中231例(21.5%)出现新的发作类型,其中部分性发作患者584例,132例(22.6%)出现新的发作类型;全面性发作患者490例,99例(20.2%)出现新的发作类型.1074例癫(癎)患者中脑电图异常者576例(53.6%),影像学异常237例(22.1%).231例出现新发作类型的癫(癎)患者中123例(53.2%)出现脑电图异常,75例(32.5%)影像学异常.有41例患者可找到出现新发作类型的可能原因.有和无新发作类型的癫(癎)患者的首次发病年龄差异无统计学意义,平均病程(Z=2.024)、神经系统体格检查和影像学检查结果有异常的比例(χ~2=23.836、18.511)差异均有统计学意义(P＜0.05).结论 一部分出现新发作类型的患者可找到原因,分析新发作类型的出现、原因对癫(癎)的诊断、治疗和预防有指导意义.     

西藏农村地区惊厥性癫(癎)患病率初步调查

目的 初步调查西藏农村地区惊厥性癫(癎)患病率、治疗缺口及患者生活质量.方法 利用统一的调查表,对西藏拉萨市墨竹工卡县工卡镇和扎西岗乡、昌都地区芒康县曲孜卡乡进行整群逐户问卷调查.结果 共调查14 822人,确诊惊厥性癫(癎)患者37例,患病率0.25%,其中活动性癫(癎)患者35例(94.59%),患病率为0.24%.调查前1周内接受西药正规治疗者1例,治疗缺口为97.1%.癫(癎)患者生活质量评定量表-31(QOLIE-31)总评分平均为(42.15±17.63)分,其中各分项得分中发作担忧得分最低[(22.59±20.31)分]、药物影响的评分最高[(85.83±18.59)分].年龄、职业、文化程度、经济状况、起病年龄、发作次数为QOLIE-31低评分的影响因素(P＜0.05).结论 西藏农村地区惊厥性癫(癎)患病率为0.25%,西药治疗缺口大,主要以藏医藏药治疗为主,对西药治疗癫(癎)的了解很少,生活质量评分低.探索藏西医结合防治癫(癎)、提高当地医护人员的癫(癎)防治知识及公众的健康意识迫在眉睫.     

癫(癎)患者先兆症状的研究

目的 探讨癫(癎)患者先兆症状的发生比例、临床表现,为正确诊断治疗癫(癎)提供依据.方法 回顾性研究1028例癫(癎)患者的临床资料,分析癫(癎)患者的先兆发生率、临床表现、脑电图和神经影像学结果.比较伴或不伴先兆的部分性发作癫(癎)患者的发病年龄、性别、脑电图、神经影像学的差异以及腹部先兆在颞叶内外侧癫(癎)出现比例的差异.结果 部分性癫(癎)725例,484例(66.8 % )出现先兆;全面性发作者303例,无一例患者出现先兆.64例患者出现2种或2种以上的先兆表现;14例出现持续性先兆的癫(癎)患者.1028例患者中脑电图异常547例(53.2 % ),影像学异常217例(21.1 % ).484例有先兆症状的患者中286例脑电图异常(59.1 % ),126例(26.0 % )影像学异常.伴或不伴先兆的部分性发作癫(癎)患者的首次发病年龄差异无统计学意义,腹部先兆在颞叶内外侧癫(癎)出现的比例差异有统计学意义(x2=170.877,P<0.01).结论 癫(癎)患者先兆症状多样,分析先兆症状对于癫(癎)分型、病灶定位以及合理治疗有指导意义.     

癫(癎)患者先兆症状的研究

目的 探讨癫(癎)患者先兆症状的发生比例、临床表现,为正确诊断治疗癫(癎)提供依据.方法 回顾性研究1028例癫(癎)患者的临床资料,分析癫(癎)患者的先兆发生率、临床表现、脑电图和神经影像学结果.比较伴或不伴先兆的部分性发作癫(癎)患者的发病年龄、性别、脑电图、神经影像学的差异以及腹部先兆在颞叶内外侧癫(癎)出现比例的差异.结果 部分性癫(癎)725例,484例(66.8 % )出现先兆;全面性发作者303例,无一例患者出现先兆.64例患者出现2种或2种以上的先兆表现;14例出现持续性先兆的癫(癎)患者.1028例患者中脑电图异常547例(53.2 % ),影像学异常217例(21.1 % ).484例有先兆症状的患者中286例脑电图异常(59.1 % ),126例(26.0 % )影像学异常.伴或不伴先兆的部分性发作癫(癎)患者的首次发病年龄差异无统计学意义,腹部先兆在颞叶内外侧癫(癎)出现的比例差异有统计学意义(x2=170.877,P<0.01).结论 癫(癎)患者先兆症状多样,分析先兆症状对于癫(癎)分型、病灶定位以及合理治疗有指导意义.     

Clinical features of convulsive status epilepticus: a study of 220 cases in western China

Background and purpose:  Convulsive status epilepticus (CSE) is the most common and life-threatening form of status epilepticus (SE). The aim of this study was to describe the clinical features of CSE in western China.
Methods:  Convulsive status epilepticus patients hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis.
Results:  The average age of CSE patients ( n  = 220) was 37.5 years (SD 20.31), 50% of the patients had a history of epilepsy. The primary cause of CSE was central nervous system infection (32.7%), followed by discontinuation or reduction of antiepileptic drugs (AEDs; 15.5%). The median duration of CSE was 5 h and median duration of seizures before treatment was 2 h; both were longer in rural patients than in urban patients ( P  < 0.05). The fatality rate on discharge was 15.9%. Logistic regression analysis showed the duration of CSE [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07], a history of epilepsy (OR 0.35, 95% CI 0.14–0.89), and respiratory depression (OR 5.96, 95% CI 2.49–14.24) were independent predictors of CSE prognosis.
Discussion:  Central nervous system infection and AEDs withdrawal in epilepsy patients were the most important causes of CSE. There is a large gap between antiepileptic therapy in China and European Status Epilepticus guidelines.     

Adult convulsive status epileptic us: clinical,etiological, and predictors of outcome study from rural population of North India

Aim: To determine the clinical profile, etiologies and predictors of mortality in patients with convulsive status epilepticus (CSE) among rural population of North India in view of limited published data on epidemiology and etiology of status epilepticus (SE) from developing countries.

Methods: One hundred sixty-two consecutive adult patients with CSE were evaluated from 2016 to 2018 for demographic profile, etiologies and predictors of poor outcome.

Results: The mean age was 41.71?±?19.72?years. Most of the CSE cases were acute symptomatic (48.8%) type with central nervous system (CNS) infections (24.1%) being the predominant precipitating factor. Antiepileptic drugs (AEDs) noncompliance accounted for 34.9% of the cases with pre-existing epilepsy. The median duration of CSE was 5.5?h (IQR-3-10?h). 82.1% cases responded to the first line drugs and their response was related with duration of CSE (p?=?.0045). Case fatality was 16.0% and the predictors of the mortality were; low Glasgow Coma Scale (GCS) (OR =9.64, 95% CI= 2.064–45.02; p?=?.0001), lack of response to first line drugs (OR =0.019, 95% CI= 0.003–0.11; p?=?.0001) and absence of past history of epilepsy (OR =0.525, 95%CI =0.104–2.66; p?=?.004).

Conclusions: CNS infection and AEDs noncompliance were identified to be the major cause of CSE which can be potentially preventable. Present study signifies that prompt and successful control of infections appears to be the most efficient preventive approach. Level of consciousness as a potential predictor of poor outcome can be quickly accessible to the treating clinician in optimizing treatment strategies.     

The aetiology of convulsive status epilepticus: A study of 258 cases in Western China

PurposeTo investigate the characteristics of the aetiologies of convulsive status epilepticus (CSE) in Western China and to identify the relationships of these aetiologies with the prognoses.MethodsConsecutive registration and prospective observation of 258 cases of CSE in the Sichuan Epilepsy Center were performed from 1996 to 2010 to study the aetiology of CSE. The relationships of the aetiologies with the demographics, outcomes and complications of CSE were analysed using a logistic regression model.ResultsThe mean age was 37.6 ± 20.21 years. The majority of the CSE (62.4%) cases were acute symptomatic cases, and the primary cause was central nervous system (CNS) infection (33.7%). Histories of epilepsy were present in 51.9% of the patients. Pre-existing epilepsy occurred due to discontinuation or reduction of antiepileptic drugs (AEDs) in 31.3% of the CSE patients. Anoxia/poisoning (p < 0.05, OR 8.0, 95% CI 1.34–47.77) was an independent predictor of mortality. CNS infections (p < 0.001, OR 8.99, 95% CI 3.52–22.92), cerebrovascular diseases (p =0.001, OR 6.75, 95% CI 2.11–21.61) and anoxia/poisoning (p < 0.01, OR 7.64, 95% CI 1.93–30.21) were the major risk factors for complications associated with CSE.Conclusions(1) Compared to developed countries, CNS infections seemed to be more likely to be the cause of CSE in developing countries. (2) Noncompliance with AEDs among patients with epilepsy was a prominent and avoidable trigger of CSE.     

Factors influencing medication adherence after epilepsy surgery

Aim. In drug‐responsive epilepsy patients, treatment non‐compliance is a major factor in seizure recurrence, but adherence to prescribed regimens following epilepsy surgery has not been examined. We measured adherence to prescribed antiepileptic drugs (AEDs) after epilepsy surgery and investigated factors influencing treatment non‐compliance. Methods. Postsurgical epilepsy patients (n=214) were monitored for 18.1±8.1 months. Adherence was measured using the Medication Possession Ratio (MPR) self‐report questionnaire, with MPR<0.8 defined as non‐adherence. Results. According to the MPR, 58 patients (27.1%) were non‐adherent after surgery. There were no differences in demographic and clinical variables, such as age (p=0.057, t =?1.925), duration of illness (p=0.597, t=0.530), gender ratio (p=0.714, χ²=0.134), and place of residence (urban vs. rural; p=0.874, χ²=0.025), between adherent and non‐adherent patients. Moreover, adherence was not related to surgical outcome as evaluated by the Engel classification (p=0.635, χ²=1.628) or to the types of AEDs after surgery (p=0.165, χ²=6.530). The most common reasons for non‐adherence were seizure‐free status for an extended period (26.5%), forgetfulness (19.1%), and an inability to buy the drugs locally (18.6%). Conclusion. Adherence to AEDs is improved after epilepsy surgery compared to presurgical estimates, but is still a common and serious problem. Targeted postsurgical management programs and communication strategies are necessary to improve adherence to AEDs after epilepsy surgery.     

不同治疗时机对新诊断癫痫患者复发和预后的影响

目的 探讨不同治疗时机对新诊断癫痫患者复发和预后的影响.方法 前瞻性收集155例新诊断癫痫患者的临床资料,根据治疗前发作次数,分为即刻治疗组(≤3次,84例)和延迟治疗组(＞3次,71例),给予合理药物治疗,至少随访1年(中位数29个月).采用Kaplan-Meier生存统计分析比较治疗后第1次发作时间和治疗失败时间[因疗效不佳和(或)不能耐受副作用而退出者],同时比较2组患者观察期内"治疗失败"和"无发作"的比例.结果 2组不同治疗时机癫痫患者第1次发作时间(即刻治疗组1484 d,延迟治疗组1104 d,x2=0.571,P=0.450)、治疗失败时间(即刻治疗组2992 d,延迟治疗组1964 d,x2=0.018,P=0.893)差异均无统计学意义;按病因(原发性、隐源或症状性)、年龄(儿童≤16岁,成人＞16岁)进行比较,2组差异亦均无统计学意义.观察期内即刻治疗组由于各种原因所致治疗失败患者20例(23.8%),延迟治疗组为16例(22.5%),差异无统计学意义(x2=0.035,P=0.852);观察期内达"无发作"患者即刻治疗组40例(47.6%),延迟治疗组30例(42.3%),差异亦无统计学意义(x2=0.447,P=0.504).结论 对于治疗前发作次数较少(≤3次)的新诊断癫痫患者,即刻治疗不影响其复发和预后.

Abstract：

Objective To explore the influence of different treatment time on the relapse and prognosis of patients with newly diagnosed epilepsy. Methods To prospectively studied the clinical characteristics of 155 patients with newly diagnosed epilepsy. Patients were separated into immediate ( n =84, seizures ≤3 times) or deferred (n =71, seizures ＞ 3 times) treatment groups according to number of seizures before treatment with appropriate antiepileptic drugs (AEDs). The patients were followed up for at least one year (median, 29 months). Kaplan-Meier survival statistics was used to analyze time to first seizure or time to treatment failure (inadequate seizure control and (or) intolerable side-effects ). The proportions of patients with treatment failure and seizure free during follow up were also compared. Results There was no significant difference in time to first seizure or time to treatment failure between immediate ( 1484 days and 2992 days) and deferred treatment ( 1104 days and 1964 days; Log-Rank test x2 =0. 571 and 0. 018 respectively, P = 0. 450 and 0. 893 ). Subgroup analyses according to etiology ( primary and cryptogenic/symptomatic epilepsy) and age (children ≤ 16 years; adult ＞ 16 years) did not reveal any difference between immediate and deferred treatment. During follow up, there were 20 treatment failure patients ( 23. 8% ) in immediate treatment group and 16 ( 22.5% ) in deferred treatment group ( no statistical difference, x2 =0. 035 ,P =0. 852). There were 40 seizure free patients (47. 6% ) in immediate treatment group and 30 (42. 3% ) in deferred treatment group ( no statistical difference, x2 = 0. 447, P =0. 504 ). Conclusions For newly diagnosed epilepsy patients with a few seizures ( seizures ≤ 3 ), immediate AEDs treatment does not affect the relapse and prognosis.     

Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy

PURPOSE: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. METHODS: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for >or=1 year during the follow-up period. RESULTS: Sixty-six (75%) patients achieved complete seizure freedom for >or=1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n=60), and in seven (12%) patients after discontinuation of AEDs (n=38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free >or=1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. CONCLUSIONS: Our results suggest that seizure freedom without aura at >or=1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.     

急性期病毒性脑炎患儿临床特点及对继发癫痫的影响

目的探讨急性期病毒性脑炎(VE)患儿临床特点,并分析影响继发癫痫(SEP)的相关因素。方法收集2014-06—2017-06就诊于郑州大学附属儿童医院的76例急性期VE患儿的临床资料,对患儿临床特点进行统计分析,采用Logistic回归模型分析影响急性期VE后SEP的危险因素。结果76例患儿中21例出现SEP,发生率为27.6%。单因素分析显示,VE后SEP组急性发作时出现癫痫持续状态、发作次数>10次的比例均明显高于非SEP组(P<0.05),急性期后继续服用抗癫痫药物(AEDs)比例明显低于非SEP组(P<0.05)。多因素Logistic回归分析显示,急性期出现癫痫持续状态(OR=1.570)、发作次数>10次(OR=1.988)是VE后发生SEP的危险因素(P<0.05),急性期后使用AEDs(OR=0.725)是VE后发生SEP的保护因素(P<0.05)。结论VE患儿SEP发生率较高,癫痫持续状态、发作次数>10次是SEP发生的独立危险因素,建议急性期继续予以AEDs以预防SEP发生。     

Profile of intractable epilepsy in a tertiary referral center

This study was undertaken to find out the profile of intractable epilepsy (IE) in a tertiary referral centre. 100 patients (males 67; females 33) with IE attending the epilepsy clinic were evaluated. Detailed history, examination, investigations like EEG and CT scan and details regarding pharmacotherapy were analysed. The age of the patients ranged from 5 to 70 yrs (mean=23.2 yrs). Mean duration of seizures was 11.44 years. Commonest seizure type was partial seizures (74%). Amongst patients with generalised seizures (26%), 14% had multiple seizure types. The seizure frequency was 12.39 +/- 21.57 (mean +/- SD) per month. Fifty seven patients were in the symptomatic group with CNS infections being the leading cause (19%) of epilepsy. Fifty patients had one or more abnormal predictors of IE. There was no difference in the severity of epilepsy in patients with no abnormal feature when compared with patients having abnormal features. EEG was abnormal in 69% cases with background abnormality in 20% and focal abnormality in 36% cases. CT scan was abnormal in 41% cases with commonest abnormality being neurocysticercosis (11%) followed by gliosis (9%) and chronic infarct (9%). Sixty patients were receiving a combination of two drugs, 32 patients 3 drugs and 8 patients were on 4 drugs. There was no difference in seizure control in patients who were on 2 drugs or more than 2 drugs. Partial seizures were the commonest seizure type leading to IE; CNS infection being the leading aetiological factor. The presence or absence of predictors of intractability does not predict severity of epilepsy. Addition of third primary drug to existing combination only increases adverse effects without better control of seizures.     

Serum thyroid hormone balance and lipid profile in patients with epilepsy

PURPOSE: Patients with epilepsy may exhibit changes in thyroid hormone balance, lipids and lipoproteins concentrations. The suggestion that lipid abnormalities are associated with subclinical thyroid dysfunction remains controversial. The aim of this study was to analyze whether thyroid dysfunction encountered in patients with epilepsy would also be associated with abnormal lipid profile. METHODS: Eighty-eight patients with epilepsy and 30 control subjects were included in the study. A fasting blood sample for thyroid hormones, lipid profile and GGT determination was obtained. RESULTS: The serum levels of FT3 was elevated in 10.2% of patients, FT4 was low in 28.4%, TSH was high in 4.6% and low in 2.3%. 13.6% of patients had high TC, 17.1% had high LDL-c, 60.2% had marked reduction of HDL-c levels (P<0.0001) and only 2.3% had high TG levels. Abnormalities were predominated in CBZ-treated patients. 27.3% patients with abnormal hormones had abnormal lipid profile. Significant association was identified between the serum TC, LDL-c, TG, GGT and EIAEDs and between the duration of illness and TG (r=-0.411; P=0.017), and FT4 (r=-0.412; P=0.018). HDL was higher in women than men (r=0.416; P<0.002). However, changes in HDL-c levels associated neither with duration of illness, type or serum levels of AEDs nor with age or degree of control on AEDs. CONCLUSIONS: Our results support that (1) altered lipid metabolism might be associated but not solely influenced by thyroid hormones and (2) enzyme induction is not the main or only reason for altered thyroid function or HDL-c among patients with epilepsy. Hypothalamic/pituitary dysregulation by precisely mechanism caused by epilepsy itself or AEDs seems possible and (3) it is important to recognize that patients with epilepsy are at great risk for atherosclerosis, hence monitoring and correction of the culprit risks are mandatory.     

Pharmacological outcomes in newly diagnosed epilepsy

The response to antiepileptic drugs (AEDs) has been examined in 780 adult and adolescent patients with newly diagnosed epilepsy presenting with a range of seizure types and epilepsy syndromes over a 20-year period. Carbamazepine (CBZ, n=312), sodium valproate (VPA, n=315), and lamotrigine (LTG, n=249) were the most common AEDs prescribed as monotherapy. More patients with localization-related epilepsies became seizure free with LTG (63%) than with CBZ (45%, P=0.006) or VPA (42%, P=0.006). For idiopathic generalized epilepsies a greater proportion of patients achieved control with VPA (68%) than with CBZ (31%) or LTG (45%). In particular, more patients with juvenile myoclonic epilepsy responded to VPA (75%) compared with LTG (39%, P=0.014). Seizure freedom was achieved with modest or moderate daily doses (median CBZ 400mg, VPA 1000 mg, (LTG) 150 mg) of all three AEDs in the majority of patients achieving remission. Time to first seizure did not differ among these three drugs when given as first treatment. Adverse effects leading to withdrawal were more frequent with CBZ (16%) than with VPA (7%, P=0.03) or LTG (7%, P=0.018). In patients failing initial monotherapy, response to a combination of two AEDs (27%) was not different from that with alternative monotherapy (32%). The majority of patients with newly diagnosed epilepsy responding to treatment did so rapidly and completely with moderate doses of AEDs, with no differences in time to first seizure.